Provider First Line Business Practice Location Address:
8313 NORTH 27TH AVENUE
Provider Second Line Business Practice Location Address:
#165
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-347-0660
Provider Business Practice Location Address Fax Number:
602-347-5328
Provider Enumeration Date:
11/15/2006